Bank Authorization

AUTHORIZATION FOR BANK ACCOUNT SUBMISSION TO AMAZON/KDP
Complete all information requested.

This form must be signed and dated by the author/creator or legal guardian who owns the bank information listed below
Author/Creator First and Last Name:
Email Address:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthdate
Phone Number:
SSN or EIN
ACCOUNT
First and Last Name of Bank Account Owner
Name of Financial Institution
Account Type:

CheckingSavings
Account number
Routing number
I have double checked the bank account information entered above is accurate*

Yes
I hereby authorize AMason/KDP, via their payment service provider and the financial institution named above, to deposit my Book royalties automatically to the specified account.
Signature of Bank Account Owner

Clear
Date

MonthDayYear
Date
Should be Empty:

AUTHORIZATION FOR BANK ACCOUNT SUBMISSION TO AMAZON/KDP